Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The type of chemotherapy used will depend on the type, stage and grade of the lymphoma as well as on your general health.
Chemotherapy is usually given into a vein (intravenously).
Chemotherapy for HIV-related non-Hodgkin lymphoma
The two most commonly used chemotherapy treatments for HIV-related NHL are the R-CHOP and RCODOX-M/IVAC.
RCHOP chemotherapy includes the chemotherapy drugs cyclophosphamide, doxorubicin and vincristine; a steroid, prednisolone; and a monoclonal antibody drug called rituximab (Mabthera ®).
RCODOX-M/IVAC includes the chemotherapy drugs cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide and cytarabine. You will also be given a monoclonal antibody drug called rituximab (Mabthera ®).
With some types of NHL there’s a higher risk of lymphoma cells going to the brain. If you have a lymphoma like this, you may be given additional treatment to reduce your risk. This may involve having chemotherapy put into the spinal fluid, called intrathecal chemotherapy. It’s done in a similar way to a lumbar puncture; before removing the needle, the doctor puts a small amount of liquid chemotherapy into the spinal fluid. Intrathecal chemotherapy can also be used to treat lymphoma that has already spread to the brain.
Chemotherapy for HIV-related Hodgkin lymphoma
Hodgkin lymphoma is often treated with the ABVD regimen, which includes the chemotherapy drugs doxorubicin, bleomycin, vinblastine and dacarbazine.
Chemotherapy involves a number of cycles of treatment. A cycle usually consists of a few days of chemotherapy treatment followed by a rest period of about 2-4 weeks.
Side effects of chemotherapy
Different chemotherapy drugs have different side effects. Your doctor or specialist nurse can tell you what to expect. You should always tell them about any side effects you have. They can give you medicines to prevent or reduce them if necessary.
The chemotherapy will temporarily reduce the number of CD4 cells. Your CD4 count will begin to increase again once you finish the course of chemotherapy. The chemotherapy shouldn’t affect the control of the HIV infection (viral load) as long as you are able to take the HAART medication.
One of the main side effects of chemotherapy is risk of infection. This happens because the chemotherapy temporarily reduces the number of white blood cells made by the bone marrow. People with HIV may already have a weakened immune system, so you will be closely monitored throughout your treatment.
You may be given treatment to prevent infections. This usually includes antibiotics and anti-viral medicines.
You may also be given injections to stimulate the bone marrow to make blood cells and increase the number of white cells in the blood. This involves having a substance called G-CSF (granulocyte-colony stimulating factor) injected under the skin (subcutaneously).
Occasionally the dose of chemotherapy may need to be reduced if the number of your white blood cells is too low.